1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am
A bill for an act
relating to human services; revising requirements for county-based purchasing
for state health care programs; appropriating money; amending Minnesota
Statutes 2007 Supplement, section 256B.69, subdivision 4.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Minnesota Statutes 2007 Supplement, section 256B.69, subdivision 4, is
amended to read:
(a) The commissioner shall develop criteria to
determine when limitation of choice may be implemented in the experimental counties.
The criteria shall ensure that all eligible individuals in the county have continuing access
to the full range of medical assistance services as specified in subdivision 6.
(b) The commissioner shall exempt the following persons from participation in the
project, in addition to those who do not meet the criteria for limitation of choice:
(1) persons eligible for medical assistance according to section 256B.055,
(2) persons eligible for medical assistance due to blindness or disability as
determined by the Social Security Administration or the state medical review team, unless:
(i) they are 65 years of age or older; or
(ii) they reside in Itasca County or they reside in a county in which the commissioner
conducts a pilot project under a waiver granted pursuant to section 1115 of the Social
(3) recipients who currently have private coverage through a health maintenance
(4) recipients who are eligible for medical assistance by spending down excess
income for medical expenses other than the nursing facility per diem expense;
(5) recipients who receive benefits under the Refugee Assistance Program,
established under United States Code, title 8, section 1522(e);
(6) children who are both determined to be severely emotionally disturbed and
receiving case management services according to section 256B.0625, subdivision 20,
except children who are eligible for and who decline enrollment in an approved preferred
integrated network under section 245.4682;
(7) adults who are both determined to be seriously and persistently mentally ill and
received case management services according to section 256B.0625, subdivision 20;
(8) persons eligible for medical assistance according to section 256B.057,
subdivision 10; and
(9) persons with access to cost-effective employer-sponsored private health
insurance or persons enrolled in a non-Medicare individual health plan determined to be
cost-effective according to section 256B.0625, subdivision 15.
Children under age 21 who are in foster placement may enroll in the project on an elective
basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an
elective basis. The commissioner may enroll recipients in the prepaid medical assistance
program for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by
spending down excess income.
(c) The commissioner may allow persons with a one-month spenddown who are
otherwise eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay
their monthly spenddown to the state.
(d) The commissioner may require those individuals to enroll in the prepaid medical
assistance program who otherwise would have been excluded under paragraph (b), clauses
(1), (3), and (8), and under Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.
(e) Before limitation of choice is implemented, eligible individuals shall be notified
and after notification, shall be allowed to choose only among demonstration providers.
The commissioner may assign an individual with private coverage through a health
maintenance organization, to the same health maintenance organization for medical
assistance coverage, if the health maintenance organization is under contract for medical
assistance in the individual's county of residence. After initially choosing a provider,
the recipient is allowed to change that choice only at specified times as allowed by the
commissioner. If a demonstration provider ends participation in the project for any reason,
a recipient enrolled with that provider must select a new provider but may change providers
without cause once more within the first 60 days after enrollment with the second provider.
(f) An infant born to a woman who is eligible for and receiving medical assistance
and who is enrolled in the prepaid medical assistance program shall be retroactively
enrolled to the month of birth in the same managed care plan as the mother once the
child is enrolled in medical assistance unless the child is determined to be excluded from
enrollment in a prepaid plan under this section.
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